Provider Demographics
NPI:1336614619
Name:BOOST PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BOOST PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-463-8920
Mailing Address - Street 1:23313 SE 32ND WAY
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-6086
Mailing Address - Country:US
Mailing Address - Phone:425-463-8920
Mailing Address - Fax:
Practice Address - Street 1:14021 NE 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4135
Practice Address - Country:US
Practice Address - Phone:425-463-8920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty